<?php 
include_once('connection/connection.php');
//session_start();
//ob_start();
include('header.php');
include('menu.php');
include('config.php');
//include('upload_file.php');
?>
<html>
<head>
<meta http-equiv="Content-Language" content="en-us">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<link href="css/style_question.css" type="text/css" rel="stylesheet" />
<script language="javascript" type="text/javascript" src="js/validate.js"></script>
<script language="Javascript" type="text/javascript" src="js/ajaxFunction.js"></script>
<script language="Javascript" type="text/javascript" src="js/ajaxFunction1.js"></script>
<script language="Javascript" type="text/javascript">
function showMe(box,id) 
{
 	var elm = document.getElementById(id)
 	elm.style.display = box.checked? "inline":"none"
}
function success()
{
	var name=document.getElementById('file').value;
	//alert(name);
	if(name != "")
	{
		alert('Kml File=' + name + ' is successfully uploaded');
	}
} 
function kml_valid()
{
	var habit_num = document.getElementById('habcount').value;
	var num_habit = document.getElementById('num_habit').value;
	//if(document.getElementById('c1').checked && !(document.getElementById('file').value==""))
	if(document.getElementById('c1').checked)
	{
		var check_val = window.document.getElementById('c1').value;
		for(i=1; i<=habit_num; i++)
		{
			document.getElementById('longitude'+i).disabled=true;
			document.getElementById('latitude'+i).disabled=true;
			//alert(document.getElementById('status'+i).value);
			
		}
	}
	else
	{
		for(i=1; i<=habit_num; i++)
		{
			document.getElementById('file').value=""
			document.getElementById('longitude'+i).disabled=false;
			document.getElementById('latitude'+i).disabled=false;
			//alert(document.getElementById('status'+i).value)
			if(document.getElementById('status'+i).value=="NON TRACABLE")
			{
				document.getElementById('longitude'+i).disabled=true;
				document.getElementById('latitude'+i).disabled=true;
			}
		}
	}
	if(document.getElementById('c1').checked)
	{
		var check_val = window.document.getElementById('c1').value;
		//alert(check_val);
		for(i=1; i<=num_habit; i++)
		{
			//alert(num_habit);
			document.getElementById('un_longitude'+i).disabled=true;
			document.getElementById('un_latitude'+i).disabled=true;
		}
	}
	else
	{
		for(i=1; i<=num_habit; i++)
		{
			document.getElementById('file').value=""
			document.getElementById('un_longitude'+i).disabled=false;
			document.getElementById('un_latitude'+i).disabled=false;
		}
	}
	/*if(!document.getElementById('c1').checked && )
	{
		var check_val = window.document.getElementById('c1').value;
		for(i=1; i<=habit_num; i++)
		{
			document.getElementById('longitude'+i).disabled=status;
			document.getElementById('latitude'+i).disabled=status;
		}
	}*/
}

</script>
<title>Questionnaire No.3</title>
</head>
<body onLoad="enable_text(false);">
<?php
date_default_timezone_set('Asia/Kolkata');
$stamp = time();
$getdate = getdate($stamp);
	////////////////////////////////////////// function for dob starts //////////////
function dpulldown($name,$d,$m,$y)//This function will provide the pulldown for date
{
	$stamp = time();
	$getdate = getdate($stamp);
	$months = array(1 => 'January','February','March','April','May','June','July','August','September','October','November','December');
	echo'<select name="'.$name.'date" class="date">';
	for($date = 1; $date <= 31; $date++)
	{
		echo'<option value="'.$date.'" ';if($d == $date) echo'selected="selected"'; echo'>'.$date.'</option>';
	}
	echo'</select>';
	echo'<select name="'.$name.'month" class="date">';
	foreach($months as $key => $value)
	{
		echo'<option value="'.$key.'" ';if($m == $key) echo'selected="selected"'; echo'>'.$value.'</option>';
	}
	echo'</select>';
	echo'<select name="'.$name.'year" class="date">';
	for($year = 2005; $year <= ($getdate['year']); $year++)
	{
		echo'<option value="'.$year.'" ';if($y == $year) echo'selected="selected"'; echo'>'.$year.'</option>';
	}
	echo'</select>';
}
if(isset($_POST['submit']))
{ 
	$id=$_POST['id'];
	$qry="Select district_name from tbl_lookup_location where district_id = '$_POST[district]'";
	$res=mysql_query($qry);
	$row=mysql_fetch_array($res);
	echo $dis_name=$row['district_name'];
	if(isset($_POST['c1']))
	{
		$fclick = true;
		$folder1='upload_kmlfiles/'.$dis_name;
		if(!is_dir($folder1))
		{
			mkdir($folder1, 0777);
		}
		$flname=$_FILES['file']['name'];
		$flname=$id . "-" . $flname;
		if($flname!='')
		{
			//if($_FILES["file"]["type"] != "image/gif" and $_FILES["file"]["type"] != "image/jpeg" and $_FILES["file"]["type"] != "image/JPEG" and $_FILES["file"]["type"] != "image/GIF" and $_FILES["file"]["type"] != "image/pjpeg")
			//{}		
			//$dir="upload_kmlfiles/";
			$dir=$folder1.'/';
			$upfile=$dir.$flname;
			move_uploaded_file($_FILES['file']['tmp_name'], $upfile);
			$success1='KML file is successfully uploaded';
	 	}
	// }
	 $zip = new ZipArchive();
			// open archive
			echo $folder1;
			if ($zip->open('upload_kmlfiles/'.$dis_name.'.zip', ZIPARCHIVE::CREATE) !== TRUE)
			{
				die ("Could not open archive");
			}
			// initialize an iterator
			// pass it the directory to be processed
			$iterator = new RecursiveIteratorIterator(new RecursiveDirectoryIterator($folder1."/"));
			// iterate over the directory
			// add each file found to the archive
			foreach ($iterator as $key=>$value) 
			{
				$zip->addFile(realpath($key), $key) or die ("ERROR: Could not add file: $key");
				//echo $key;
				//echo $value;
			}
			// close and save archive
			$zip->close();
			}
		$check=$_POST['c1'];
		$_SESSION['check']=$check;
		$dob = $_POST['dobyear'].'-'.$_POST['dobmonth'].'-'.$_POST['dobdate'];
		$form_id=$_POST['form_id'];
		$_SESSION['form_id']=$form_id;
		//$id=$_POST['id'];
		$district=$_POST['district'];
		$_SESSION['district']=$district;
		if($district == '391' || $district == '393' || $district == '396' || $district == '400' || $district == '405' || $district == '411' || $district == '414')
		{
			$_SESSION['survey'] = 1;
		}
		else
		{ 
			$_SESSION['survey'] = 0; 
		}
		//echo $_SESSION['survey'];
		$block=$_POST['block'];
		$tehsil=$_POST['tehsil'];
		$panchayat=$_POST['panchayat'];
		$steam=$_POST['steam'];
		//$file=$_POST['file'];
		$village=$_POST['village'];
		$cvc=$_POST['cvc'];
		$pname1=$_POST['person_name1'];
		$pname2=$_POST['person_name2'];
		$pname3=$_POST['person_name3'];
		$pname4=$_POST['person_name4'];
		$pname5=$_POST['person_name5'];
		$pname6=$_POST['person_name6'];
		$pname7=$_POST['person_name7'];
		
		$q1="INSERT INTO tbl_dtls_q3_loc(id, form_id, district_id, date, block_id, tehsil_id, panchayat_id, survey_team,  file_name, village_id, census_vil_code, person_phed_officer, person_phed_sub, person_sarpanch, person_gramsevak, person_patwari, person_headmaster, person_phed_operator, post_date) VALUES('$id', '$form_id', '$district', '$dob','$block', '$tehsil', '$panchayat', '$steam', '$flname', '$village', '$cvc', '$pname1', '$pname2', '$pname3', '$pname4', '$pname5', '$pname6', '$pname7', NOW())";
			//echo $q1;
			$r1=mysql_query($q1);
			if($r1)
			{
				//header('Location: questionnaire3_2.php');
				//echo "success 1";	
				$relocatePage=true;	
			}
			else 
			{
				$errorIns="Error inserting location table <br>";
			}
			/*-------------------------------------------------*/
			$q2="SELECT DISTINCT habitation_code, habitation_name from tbl_lookup_location where census_village_code='$cvc' order by habitation_code";
			$r2=mysql_query($q2);
			$num_rows = mysql_num_rows($r2);
			$q3="SELECT id FROM tbl_dtls_q3_loc where form_id='$form_id'";
			$r3=mysql_query($q3);
			$x=mysql_fetch_array($r3);
			$loc_id=$x['id'];
			$_SESSION['loc_id']=$loc_id;
			for($i=1; $i<=$num_rows; $i++)
			{
				$hname = 'name_habi'.$i;
				$hcode = 'habi_code'.$i;
				$type_habit='type_habit'.$i;
				$household = 'household'.$i;
				$status = 'status'.$i;
				$longitude='longitude'.$i;
				$latitude='latitude'.$i;
				$sc = 'population_sc'.$i;
				$st = 'population_st'.$i;
				$other = 'population_other'.$i;
				$total = 'population_total'.$i;
				$hname=$_POST[$hname];	
				$hcode=$_POST[$hcode];
				$type_habit=$_POST[$type_habit];
				$household=$_POST[$household];
				$status=$_POST[$status];
				$longitude=$_POST[$longitude];
				$latitude=$_POST[$latitude];
				$sc=$_POST[$sc];
				$st=$_POST[$st];
				$other=$_POST[$other];
				$total=$_POST[$total];
				
				$q4="INSERT INTO tbl_dtls_q3_habit(loc_id, habit_name, habit_code, type_habit, num_household_oh, status_e_nt, longitude, latitude, population_sc, population_st, population_other, population_total) VALUES ('$loc_id', '$hname', '$hcode', '$type_habit', '$household', '$status', '$longitude', '$latitude', '$sc', '$st', '$other', '$total')";
				$r4=mysql_query($q4);	
			}	
			if($r4)
			{
				$relocatePage=true;
				//echo "success 2";
			}
			else 
			{
				$errorIns.="Error inserting habit table <br>";
			}
			$num_habit=$_POST['num_habit'];
			for($i=1; $i<=$num_habit; $i++)
			{
				$un_habit='un_habit'.$i;
				$un_habit=$_POST[$un_habit];
				$un_longitude=$_POST[un_longitude];
				$un_latitude=$_POST[un_latitude];
				$q5="INSERT INTO tbl_dtls_q3_unhabit(loc_id, unhabit_name, un_longitude, un_latitude) VALUES ('$loc_id', '$un_habit', '$un_longitude', '$un_latitude' )";
				$r5=mysql_query($q5);	
			}	
			if($r5)
			{
				$relocatePage=true;
				//echo "success 2";
			}
			else 
			{
				$errorIns.="Error inserting un_habit table <br>";
			}
			
			if($errorIns==0) 
			{
				header('Location: questionnaire3_2.php');
			}
			else 
			{
				echo $errorIns;exit;
			}
}
else
{
	$fclick = false;
	$flag=0;
}
?>
<div align="center">
<form action="" method="post" enctype="multipart/form-data" name="questionnaire3" id="questionnaire3" onSubmit="success()">
	<table border="0" width="800" id="table1" cellspacing="0" cellpadding="0">
		<tr>
			<td height="30" colspan="2">
			<p align="center">
			<font face="Verdana" style="font-size: 10pt; font-weight: 700" color="#000000">
			Questionnaire No. 3</font></p></td>
		</tr>
		<tr>
			<td height="19" colspan="2">
			<p align="center">
			<font face="Arial" style="font-size: 8.5pt" color="#000000">For 
			Field Survey (Village Level questionnaire) </font></p></td>
		</tr>
		<tr>
			<td height="18" colspan="3">
			<p align="center">
			<font style="font-size: 8.5pt" face="Arial" color="#000000">Page 1 </font></td>
		</tr>
		<tr>
			<td height="19" colspan="2" align="center"><font face="Arial" style="font-size: 8.5pt" color="#000000">(This Web Application is More Compatible with Mozilla Firefox and Google Chrome)</font></td>
		</tr>
		<tr>
			<td colspan="2">&nbsp;</td>
		</tr>
		<!--<tr>
			<td height="23" colspan="2" bgcolor="#EEEEEE"><font color="#000000">&nbsp;
			<font style="font-size: 8.5pt; font-weight: 700" face="Arial">
			Upload KML File </font></font></td>
		</tr>
		<tr bgcolor="#FDF9EE">
				  	<td width="318" colspan="4">&nbsp;&nbsp;<input type="checkbox" name="c1" id="c1" value="kml_file" onClick="kml_valid(this.checked);showMe(this,'up_file')">&nbsp;&nbsp;<font face="Verdana" style="font-size: 8.5pt" color="#000000">Upload Location as Kml File</font></td>
				</tr>	
				<tr bgcolor="#FDF9EE">
					<td colspan="4"><div id="up_file" class="hideme">
							<table border="0" width="315" id="table16" cellpadding="0">
							<tr bgcolor="#FDF9EE">
								<td width="90"><font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp;&nbsp;Upload File</font></td>
								<td width="219"><input type="file" name="file" id="file" value=""></td>
							</tr>
					  </table></div></td>
				</tr>	
				<tr>
					<td height="6" colspan="4">
					<span style="font-size: 4pt">&nbsp;</span></td>
				</tr>-->
		<tr>
			<td height="23" colspan="2" bgcolor="#EEEEEE"><font color="#000000">&nbsp;
			<font style="font-size: 8.5pt; font-weight: 700" face="Arial">
			Location </font></font></td>
		</tr>
		<tr>
			<td height="105" colspan="2">
			<table width="800" height="185" border="0" cellpadding="0" cellspacing="1" bgcolor="#FDF9EE" id="table2">
				<tr>
					<td height="6" colspan="4">
					<span style="font-size: 4pt">&nbsp;</span></td>
				</tr>
				
				
				<tr>
					<td width="157" height="34">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp; 
					<font color="#FF0000">*</font>District</font></td>
					<td width="270"><font id=district>
						<select name="district" id="district" class="txt">
						<option value="0">Select District</option>
        				</select></font><span id="districtLoader"></span>
						<!--<font id="factor">
					<input type="text" size="20" class="txt5"></font>--></td>
        			<td width="111">
						<font face="Verdana" style="font-size: 8.5pt" color="#000000"><font color="#FF0000">*</font>Date&nbsp;&nbsp;</font>					</td>
            		<td width="207">
						 <?php dpulldown('dob',$getdate['mday'],$getdate['mon'],$getdate['year']);?></td>
        		</tr>
				<tr>
					<td width="157" height="36">
						<font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp;
						<font color="#FF0000">*</font>Block </font></td>
					<td width="270"><font id=block>
						<select name="block" class="txt">
						<option value="0">==============</option>
						</select></font><span id="blockLoader"></span></td>
					<td width="111">
					<!--<p align="right">-->
						<font face="Verdana" style="font-size: 8.5pt" color="#000000"><font color="#FF0000">*</font>Revenue Tehsil&nbsp;&nbsp;&nbsp;</font></td>
					<td width="207"><font id=tehsil>
					<select name="tehsil" class="txt">
						<option value="0">==============</option>
					</select></font><span id="tehsilLoader"></span></td>
			    </tr>
				<tr>
					<td width="157" height="38">
						<font face="Verdana" style="font-size: 8.5pt" color="#000000"><font color="#FF0000">&nbsp;&nbsp;*</font>Grampanchayat</font>					</td>
					<td width="270"><font id=panchayat>
						<select name="panchayat" class="txt">
						<option value="0">==============</option>
						</select></font><span id="panchayatLoader"></span></td>
					<td width="111">
						<!--<p align="right">-->
						<font face="Verdana" style="font-size: 8.5pt" color="#000000"><font color="#FF0000">*</font>Survey Team&nbsp;&nbsp;&nbsp; </font>
						</p>					</td>
					<td width="207">
						<select size="1" name="steam" id="steam" class="txt" >
						<option selected value="0">Select Survey Team</option>
						<?php 
						foreach($survey_team as $key=>$val)
						{
		   					echo "<option value=\"$val\">$val</option>";
						}
						?>
						</select></td>
				</tr>
				
		  <!--</table></td></tr>
		<tr>
			<td height="5" colspan="2"><span style="font-size: 4pt">&nbsp;</span></td>
		</tr>-->
		<!--<tr>
			<td colspan="2">
			<table border="0" width=" 800" id="table3" bgcolor="#FDF9EE" cellspacing="1" cellpadding="0">
				<tr>
					<td colspan="4">
					<span style="font-size: 4pt">&nbsp;</span></td>
				</tr>-->
				<tr>
					<td width="155" height="37" rowspan="1" valign="top" style="text-align: center">
						<font style="font-size: 8.5pt" face="Verdana" color="#000000"><font color="#FF0000">*</font>Name of the Census Village / Main Habitation </font>					</td>
					<td width="272"><font id=village>
						<select name="village" class="txt">
						<option value="0">==============</option>
						</select></font><span id="villageLoader"></span></td>
					<td width="111" rowspan="" valign="top">
						<!--<p align="center">-->
						<font style="font-size: 8.5pt" face="Verdana" color="#000000"><font color="#FF0000">*</font>Census Village &nbsp;&nbsp;Code</font>					</td>
					<td width="207"><font id=cvc>
						<input type="text" size="20" class="txt">	
						</font></td>
				</tr>
				<!--<tr>
					<td width="272">&nbsp;</td>
					<td width="207">&nbsp;</td>
				</tr>-->
				<tr>
					<td width="155">&nbsp;</td>
					<td width="272">&nbsp;</td>
					<td width="111"><font style="font-size: 8.5pt" face="Verdana" color="#000000"><font color="#FF0000">*</font>Form Id</font> </td>
					<td width="207"><div id="form_id">
					<input type="text" size="20" class="txt">	
				</div></td>
				</tr>
			  </table></td></tr>
		<tr>
			<td colspan="2">&nbsp;</td>
		</tr>
		<tr>
			<td height="23" colspan="2" bgcolor="#EEEEEE"><font color="#000000">&nbsp;
			<font style="font-size: 8.5pt; font-weight: 700" face="Arial">
			Upload KML File </font></font></td>
		</tr>
		<tr bgcolor="#FDF9EE">
				  	<td width="318" colspan="4">&nbsp;&nbsp;<input type="checkbox" name="c1" id="c1" value="kml_file" onClick="kml_valid();showMe(this,'up_file')">&nbsp;&nbsp;<font face="Verdana" style="font-size: 8.5pt" color="#000000">Upload Location as Kml File</font></td>
				</tr>	
				<tr bgcolor="#FDF9EE">
					<td colspan="4"><div id="up_file" class="hideme">
							<table border="0" width="315" id="table16" cellpadding="0">
							<tr bgcolor="#FDF9EE">
								<td width="90"><font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp;&nbsp;Upload File</font></td>
								<td width="219"><input type="file" name="file" id="file" value=""></td>
							</tr>
							<!--<tr><td colspan="2" align="center"><input type="button" name="upload" value="Upload" onClick="up_kml()"></td></tr>-->
					  </table>
					</div></td>
				</tr>	
				<tr>
					<td height="19" colspan="4">
					<span style="font-size: 4pt">&nbsp;</span></td>
				</tr>
		<tr>
			<td height="22" colspan="2" bgcolor="#EEEEEE"><font color="#000000">&nbsp;
			<font style="font-size: 8.5pt; font-weight: 700" face="Arial">
			1. Habitation Details </font></font></td>
		</tr>
		<tr>
			<td colspan="2">
			<table border="0" width="800" id="table4" cellspacing="1" cellpadding="0" bgcolor="#FDF9EE">
				<tr>
					<td colspan="9"><span style="font-size: 4pt">&nbsp;</span></td>
				</tr>
				<tr>
					<td width="22%" align="center" rowspan="2" bgcolor="#F7E6B7">
					<font style="font-size: 8.5pt" face="Verdana" color="#990000">
					Name of the Other Habitation</font></td>
					<td align="center" width="10%" rowspan="2" bgcolor="#F7E6B7">
					<address>
						<font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#990000">
						Code No. </font>
					</address>
					<address>
					<font face="Verdana" color="#990000" style="font-size: 8.5pt; font-style: normal">
						(Census Village/ IMIS)</font>
				  </address></td>
					<td align="center" width="5%" rowspan="2" valign="top" bgcolor="#F7E6B7">
					<address>
						<font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#990000">
				  Type MH/ OH</font>
					</address></td>
					<td align="center" width="6%" rowspan="2" bgcolor="#F7E6B7">
					<address><font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#990000"><font color="#FF0000">**</font>Status</font></address>
				  <address><font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#990000">(E/ NT)</font></address></td>
					<td align="center" width="9%" rowspan="2" bgcolor="#F7E6B7"><font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#990000">Longitude</font></td>
					<td align="center" width="10%" rowspan="2" bgcolor="#F7E6B7"><font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#990000">Latitude</font></td>
					<td align="center" width="8%" rowspan="2" bgcolor="#F7E6B7">
						<font style="font-size: 8.5pt" face="Verdana" color="#990000">
						<font color="#FF0000">*</font>Approx No. of Household in OH</font></td>
					<td align="center" height="22" colspan="4" bgcolor="#F7E6B7">
						<font style="font-size: 8.5pt" face="Verdana" color="#990000">Current Population(2010)</font></td>
				</tr>
				<tr>
					<td width="8%" align="center" bgcolor="#F7E6B7">
						<font style="font-size: 8.5pt" face="Verdana" color="#990000">SC</font></td>
					<td width="8%" align="center" bgcolor="#F7E6B7">
						<font style="font-size: 8.5pt" face="Verdana" color="#990000">ST</font></td>
					<td width="7%" align="center" bgcolor="#F7E6B7">
						<font style="font-size: 8.5pt" face="Verdana" color="#990000">Others</font></td>
					<td width="7%" align="center" bgcolor="#F7E6B7">
						<font style="font-size: 8.5pt" face="Verdana" color="#990000">Total</font></td>
				</tr>
			</table></td></tr>	
		<tr>
			<td colspan="2"><div id="habit"></div></td>
		</tr>
		<tr><td colspan="9">&nbsp;</td></tr>
		<tr>
			<td width="179" height="22" bgcolor="#EEEEEE"><font color="#000000">&nbsp;
			<font style="font-size: 8.5pt; font-weight: 700" face="Arial">No. of Unlisted Habitation</font></font></td>
			<td width="571" bgcolor="#EEEEEE"><input type="text" name="num_habit" id="num_habit" value="" class="txt5" onKeyUp="showhabit();numeric(this)"></td>
		</tr>
		<tr><td colspan="2">&nbsp;</td></tr>
		<tr>
			<td colspan="2"><div id="show_unhabit"></div></td>
		</tr>
		<tr><td colspan="2">&nbsp;</td></tr>
		<tr>
			<td height="22" colspan="2" bgcolor="#EEEEEE"><font color="#000000">&nbsp;
			<font style="font-size: 8.5pt; font-weight: 700" face="Arial">
			2. </font></font><span style="font-weight: 700">
			<font face="Arial" style="font-size: 8.5pt" color="#000000">Name of 
			Key Person (s) Contacted/ Interviewed - <font color="#FF0000">At least one</font></font></span></td>
		</tr>
		<tr>
			<td colspan="2">
				<table border="0" width=" 800" id="table5" bgcolor="#FDF9EE" cellspacing="1" cellpadding="0">
				<tr>
					<td colspan="4">
					<span style="font-size: 4pt">&nbsp;</span></td>
				</tr>
				<tr>
					<td width="256">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp; 
					Concerned PHED Officer (AEn / JEn) </font></td>
					<td width="60"><input type="checkbox" name="cpo" value="cpo" onClick="enable_text1(this.checked)"></td>
					<td width="147"><input type="text" name="person_name1" id="person_name1" size="25" class="txt" value=""></td>
					<td width="294">&nbsp;</td>
				</tr>
				<tr>
					<td width="256">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp; 
					PHED Sub- Division</font></td>
					<td width="60"><input type="checkbox" name="psd" value="psd" onClick="enable_text2(this.checked)"></td>
					<td width="147"><input type="text" name="person_name2" id="person_name2" size="25" class="txt" value=""></td>
					<td width="294">&nbsp;</td>
				</tr>
				<tr>
					<td width="256">
					<font face="Verdana" style="font-size: 8.5pt" color="#000000">&nbsp; Sarpanch / Dy. Sarpanch</font></td>
					<td width="60"><input type="checkbox" name="sds" value="sds" onClick="enable_text3(this.checked)"></td>
					<td width="147"><input type="text" name="person_name3" id="person_name3" size="25" class="txt" value=""></td>
					<td width="294">&nbsp;</td>
				</tr>
				<tr>
					<td width="256">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">&nbsp; 
					Gram Sewak </font></td>
					<td width="60"><input type="checkbox" name="gs" value="gs" onClick="enable_text4(this.checked)"></td>
					<td width="147"><input type="text" name="person_name4" id="person_name4" size="25" class="txt" value=""></td>
					<td width="294">&nbsp;</td>
				</tr>
				<tr>
					<td width="256" height="20">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">&nbsp; 
					Patwari </font></td>
					<td width="60" height="20"><input type="checkbox" name="patwari" value="patwari" onClick="enable_text5(this.checked)">                    </td>
					<td width="147" height="20"><input type="text" name="person_name5" id="person_name5" size="25" class="txt" value=""></td>
					<td width="294" height="20">&nbsp;</td>
				</tr>
				<tr>
					<td width="256" height="20">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">&nbsp; 
					Head Master, Govt. School</font></td>
					<td width="60" height="20"><input type="checkbox" name="hms" value="hms" onClick="enable_text6(this.checked)"></td>
					<td width="147" height="20"><input type="text" name="person_name6" id="person_name6" size="25" class="txt" value=""></td>
					<td width="294" height="20">&nbsp;</td>
				</tr>
				<tr>
					<td width="256" height="20">
					<font style="font-size: 8.5pt" face="Verdana" color="#000000">&nbsp; 
					PHED Operator / Staff</font></td>
					<td width="60" height="20"><input type="checkbox" name="phed" value="phed" onClick="enable_text7(this.checked)"></td>
					<td width="147" height="20"><input type="text" name="person_name7" id="person_name7" size="25" class="txt" value=""></td>
					<td width="294" height="20">&nbsp;</td>
				</tr>
				<tr>
					<td width="757" height="20" colspan="4">&nbsp;</td>
				</tr>
				</table>			</td>
		</tr>
		<tr>
			<td colspan="2">&nbsp;</td>
		</tr>
		<tr>
			<td colspan="2"><font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#FF0000">*Fields are mandatory</font>			</td>
		</tr>
		<tr>
			<td colspan="2">&nbsp;</td>
		</tr>
		<tr>
			<td colspan="2"><font style="font-size: 8.5pt; font-style: normal" face="Verdana" color="#FF0000">**Status: E-Existing/ NT-Not Traceable</font>			</td>
		</tr>
		<tr>
			<td colspan="2">&nbsp;</td>
		</tr>
		<tr>
			<td colspan="2">
			<p align="center">
			<input type="submit" value="Click for Continue" name="submit" style="font-size: 8pt; font-family: Verdana; border-style: solid; border-width: 1px" onClick="return validate()">&nbsp;</p>			</td>
		</tr>
		</table>
</form>		
</div>

</body>
</html>